Hypertensive disorders of pregnancy (HDP), including preeclampsia and gestational hypertension, are associated with a two-fold increased long-term risk of dilated cardiomyopathy, according to a recently published large UK population-based cohort study.
This finding addresses an important knowledge gap where the impact of HDP on developing dilated cardiomyopathy was previously unknown.
Drawing on linked UK national datasets covering over 84,000 individuals, the study found that women with HDP during their first pregnancy had a 93% higher risk of developing dilated cardiomyopathy.
Even after adjusting for multiple variables such as maternal age, gestational diabetes, postpartum hypertension and socioeconomic status, the association remained significant (adjusted hazard ratio (HR) 1.55).
Dilated cardiomyopathy risk rises with HDP severity
The researchers also noted a clear ‘dose-response’ relationship: the risk was higher among women who had preeclampsia (HR 1.85) and markedly higher in those with severe preeclampsia (HR 4.29).
Older maternal age (HR per year of age, 1.06) and postpartum hypertension (HR 1.68) were also independently associated with higher risk of developing the condition after a hypertensive disorder of pregnancy.
Median time to diagnosis of dilated cardiomyopathy was just 5.1 years postpartum among women with HDP, compared with 10.6 years for women with normotensive pregnancies.
Long-term clinical vigilance required
Underscoring the clinical importance of the findings, lead author Dr Paz Tayal stressed the need for healthcare systems to incorporate female-specific cardiovascular risk factors into long-term monitoring frameworks.
‘We need to be vigilant for the development of dilated cardiomyopathy in women with a history of hypertensive disorders of pregnancy,’ she said.
Indeed, the earlier onset of the condition in this population highlights a crucial opportunity for proactive surveillance and prevention.
The findings suggested either a shared predisposition to HDP and dilated cardiomyopathy or a cascade effect, in which HDP initiates a trajectory of cardiovascular strain, compounded by future hypertension.
This study builds on Dr Tayal’s previous work on sex differences in dilated cardiomyopathy, which suggests that the condition will continue to remain underdiagnosed in women unless clinicians remain vigilant and apply sex-specific criteria for diagnosis.
Reference
Tayal U et al. Hypertensive disorders of pregnancy and long-term risk of dilated cardiomyopathy. JAMA Cardiol 2025;10(5):498-502.
